Blackburn with Darwen – Improving efficiency and outcomes through telehealthcare
“Despite facing significant cuts to adult social care funding, we have been able to deliver an improved service for our residents. Our decision to invest in telehealthcare underlines our ongoing commitment to delivering the best possible care services to our residents, and our willingness to embrace new technologies to achieve this.”
Harry Catherall, Chief Executive, Blackburn with Darwen Borough Council
Blackburn with Darwen Borough Council is ranked as the 17th most deprived Local Authority in England out of 326 on the Index of Multiple Deprivation 2010, and the area faces some significant demographic challenges in the future with the number of people aged 85+ set to increase by 12.5% between 2010 and 2021.
The Borough has had one the highest rates of admission to residential care in the North West, and the number of people aged 65+ with dementia is projected to increase by 53% between 2010 and 2030 to 1,910.
Blackburn with Darwen is also home to above average numbers of people with long-term conditions and mental health issues, with both groups being high users of health and social care services. NHS Blackburn with Darwen CCG has the fifth highest rate of unplanned hospitalisation for chronicnambulatory care sensitive conditions in England with 1,446 emergency admissions per 100,000.2.
The Council needed to address these issues to manage current and future demand, and improve outcomes for local people. At the same time, budget efficiencies meant considerable savings needed to be made from the social care budget.
How could the Council deliver improved health and social care support and at the same time significantly reduce costs?
Working in partnership with Tunstall and Care Services Efficiency Delivery programme (CSED), the Council put in place a ‘hearts and minds’ engagement programme for stakeholders, identifying barriers to the successful implementation of the telecare service and putting in place plans to overcome them. A concern for social workers was that they would need to manage or
might be liable for any problems with equipment should they occur, and this was addressed by ensuring they were clear about the structure and processes in place to support the service. Real life case examples were used as a powerful way of illustrating the benefits and impact of telecare to a wide and diverse range of stakeholders.
The change management programme also included an exercise to ensure the referral system was simple and easy to use and that associated processes such as assessment, installation and review were simple, transparent and robust.
It was also vital to integrate telecare into the community Reablement process and rapid response service, creating a universally accessible service.
- Total net savings achieved for telecare and Reablement £2.2m in 2011-12
- Further reduction of £1.2m 2013/14 (direct budget costs)
- Residential care admissions reduced significantly, with Blackburn with Darwen having moved from 23rd in the northwest to 17th in terms of care home admissions out of the total of 23 authorities
- Telecare users have risen from 60 to 1,900 (2010/11 – 2013/14)
The number of telecare service users in Blackburn with Darwen has increased from 60 in 2010/11 to 1,910 in 2013/14. The Council undertook a robust evaluation of the service with assistance from CSED, tracking results by individual service users and reporting outcomes monthly and quarterly. Each social worker noted the alternative outcome had telecare not been in place in order to assess the impact of the service. This was in turn used to calculate cashable and cash avoidance savings in detail.
The evaluation covered the year period 30 June 2008 to 30 August 2010, and 114 service users in receipt of telecare were used for the evaluation, of which 34 received no other services. In considering the outcome of telecare, 56% (64) of installations are purely to support prevention, either on top of an existing care package or provided to people who would have received no other services. In these instances, there would be no immediate alternative to telecare.
Telecare provided to the remaining 50 people avoided the escalation of care as follows:
- 1 escalation of 24-hour care
- 2 residential/nursing continuing health care
- 1 increase in day care
- 29 home care
- 2 nursing care
- 13 residential care
- 2 escalation of supported living
The service has built upon these positive initial results, and the latest evaluation shows that residential care admissions have been reduced by 18% (or equivalent to 57 people) in 2011/12. Total net savings achieved are £2.2 million, £300,000 over the target set, made up of £1.4 million savings from the telecare and Reablement service and a further £800,000 saved solely as a result of the telecare service.
We interviewed Steve Tingle, Director of Adult Social Services at Blackburn with Darwen Borough Council and other Directors of Social Services about how they are using technology enabled services in their councils.
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